Japy Angelini Oliveira Filho

Effects of home-based exercise training for patients with chronic heart failure and sleep apnoea: a randomized comparison of two different programmes

Objective: To evaluate the effects of home-based exercise for patients with chronic heart failure and sleep apnoea and to compare two different training programmes. Design: A randomized, prospective controlled trial. Setting: Department of Cardiology, University Hospital, Brazil. Subjects: Fifty chronic heart failure patients with sleep apnoea were randomized in three groups: Group 1 (aerobic training, n = 18), Group 2 (aerobic with strength training, n = 18), and Group 3 (untrained, n = 14). Interventions: The training programme for Groups 1 and 2 began with three supervised exercise sessions, after they underwent three months of home-based exercise. Patients were followed by weekly telephone call and were reviewed monthly. Group 3 had the status of physical activity evaluated weekly by interview to make sure they remained untrained. Main outcome measures: At baseline and after three months: cardiopulmonary exercise testing, isokinetic strength and endurance, Minnesota living with heart failure questionnaire and polysomnography. Adherence was evaluated weekly. Results: Of the 50 patients enrolled in the study, 45 completed the programme. Clinical events: Group 1 (one death), Group 2 (one myocardial infarction), Group 3 (one death and two strokes). None were training related. Training groups showed improvement in all outcomes evaluated and the adherence was an important factor (Group 1 = 98.5% and Group 2 = 100.2%, P = 0.743). Untrained Group 3 demonstrated significant decrease or no change on measurements after three months without training. Conclusion: Home-based exercise training is an important therapeutic strategy in chronic heart failure patients with sleep apnoea, and strength training resulted in a higher increase in muscle strength and endurance.

Correlação entre qualidade de vida e capacidade funcional na insuficiência cardíaca

BACKGROUND: Patients with cardiac failure (CF) present progressive incapacity and decreased quality of life, both related to dyspnea and fatigue. Thus, there is the increasing interest in measring the quality of life (QL), by generic instrument, such as the 36-item Short-Form Health Survey (SF-36), by specific instrument, such as Minnesota Living with Heart Failure (MLHFQ). OBJECTIVE: This study has the objective to correlate the QL surveys, SF-36 and MLHFQ, with the functional capacity of patients with CF, expressed by the cardiopulmonary test and the TC6M. METHODS: Using the SF-36 and MLHFQ surveys for QL evaluation, for the evaluation of the functional capacity, it was used the cardiopulmonary test, being executed using a tredmill with Weber protocol, as well sa the distance covered in the walk test of six minutes (TC6M). RESULTS: Forty-six patients were selected with CF diagnosis (22 men, average age of 52 years old), classes II and III of New York Heart Association. It was observed that the mild correlation between the physical and emotional domains of SF-36 and VE/VCO2.peak (r=-0.3; p<0.05) and the distance covered in TC6M (r=0.4; p<0.05), respectively. It was also observed the mild to moderate correlations of MLHFQ total score with VO2.peak (r=-0.5; p<0.05), the aerobic threshold (r=-0.4; p<0.05) and the distance covered in TC6M (r=-0.5; p<0.05). CONCLUSION: The data suggest that the application of both evaluation instruments of QL, generic (SF-36) and specific (MLHFQ) in patients with CF, showed mild and moderate correlation with the variable of the cardiopulmonary test with the variables of the cardiopulmonary test and the distance covered in TC6M.

Coronary risk in a cohort of Paralympic athletes

Objective: To determine the prevalence of coronary risk factors in Paralympic athletes and evaluate their risk of coronary events. Method: An observational prospective cross sectional study of 79 consecutive Brazilian Paralympic athletes (mean (SD) age 27.8 (6.7) years (median 26 years)). There were 56 men and 23 women, 67 with physical and 12 with visual disabilities. The occurrence of systemic hypertension, hypercholesterolaemia, diabetes mellitus, smoking, familial antecedents, obesity, and hypertriglyceridaemia was investigated. The risk of coronary events was calculated using the American Heart Association Coronary risk handbook, and also the 10 year probability of a coronary event using the Framingham risk score. Results: The prevalence of risk factors was: systemic hypertension, 11%; familial antecedents, 10%; smoking, 9%; hypertriglyceridaemia, 6%; hypercholesterolaemia, 1.3%; obesity, 4%; diabetes, 0%. They occurred in 51% of the Paralympic athletes: one factor (41%), two factors (4%), and three factors (6%). The risk of coronary events was absent in 80%, slight in 17%, and moderate in 3%. This could only be evaluated in 81% of the athletes, as 8% had amputations, 9% were young, and 2% had unknown familial antecedents. The Framingham risk score ranged from −14 to +6, predicting a 10 year probability of a coronary event of 3.3 (3.8)%. Conclusion: This study shows a reasonably high prevalence of coronary risk factors (51%), despite a low probability of coronary events in Paralympic athletes. The lipid and blood pressure profiles were similar in ambulatory and wheelchair athletes.

Ankle-brachial index and ventricular hypertrophy in arterial hypertension

The ankle-brachial index (ABI) is a marker of peripheral arterial disease. Very few reports have correlated this index with left ventricular hypertrophy (LVH), functional capacity (FC) and Framingham risk score (FRS). The objective of this study was to verify the correlation between ABI, LVH, FC and FRS in men with arterial hypertension (AH). Prospective and cross-sectional study of male patients (n = 40) with a mean age of 57.92 ± 7.61 years and no cardiovascular complications. This population was submitted to ABI measurements, echocardiography (ECHO), exercise test (ET) and laboratory tests. The ABI (right and left) was considered abnormal when the ratio between the highest mean systolic pressures of the ankles and arms was 0.9 or higher than 1.3 mmHg. LVH was identified by transthoracic ECHO and the FC by the ET. Peripheral blood samples were collected to calculate the FRS. Normal ABI values were observed in 33 patients (82.5%), who were included in Group I; seven patients (17.5%) with abnormal ABI constituted Group II. Left ventricular mass index (LVMI) at the ECO were 111.18 ± 34.34 g/m2 (Group I) and 150.29 ± 34.06 g/m2 (Group II) (p = 0.009). The prevalence of LVH was 4% (Group I) and 35.3% (Group II) (p = 0.01), demonstrating a significant difference between the groups. As for the FC in ET, there was no difference between the groups. Regarding the FRS, the mean in Group I was below that in Group II: 13.18 ± 2.11 versus 15.28 ± 1.79 (p = 0.019). In hypertensive patients, the presence of LVH defined by the LVMI was more frequent in cases with abnormal ABI, identifying a higher cardiovascular risk.The ankle-brachial index (ABI) is a marker of peripheral arterial disease. Very few reports have correlated this index with left ventricular hypertrophy (LVH), functional capacity (FC) and Framingham risk score (FRS). The objective of this study was to verify the correlation between ABI, LVH, FC and FRS in men with arterial hypertension (AH). Prospective and cross-sectional study of male patients (n = 40) with a mean age of 57.92 ± 7.61 years and no cardiovascular complications. This population was submitted to ABI measurements, echocardiography (ECHO), exercise test (ET) and laboratory tests. The ABI (right and left) was considered abnormal when the ratio between the highest mean systolic pressures of the ankles and arms was 0.9 or higher than 1.3 mmHg. LVH was identified by transthoracic ECHO and the FC by the ET. Peripheral blood samples were collected to calculate the FRS. Normal ABI values were observed in 33 patients (82.5%), who were included in Group I; seven patients (17.5%) with abnormal ABI constituted Group II. Left ventricular mass index (LVMI) at the ECO were 111.18 ± 34.34 g/m(2) (Group I) and 150.29 ± 34.06 g/m(2) (Group II) (p = 0.009). The prevalence of LVH was 4% (Group I) and 35.3% (Group II) (p = 0.01), demonstrating a significant difference between the groups. As for the FC in ET, there was no difference between the groups. Regarding the FRS, the mean in Group I was below that in Group II: 13.18 ± 2.11 versus 15.28 ± 1.79 (p = 0.019). In hypertensive patients, the presence of LVH defined by the LVMI was more frequent in cases with abnormal ABI, identifying a higher cardiovascular risk.

Índice tornozelo-braquial e hipertrofia ventricular na hipertensão arterial

The ankle-brachial index (ABI) is a marker of peripheral arterial disease. Very few reports have correlated this index with left ventricular hypertrophy (LVH), functional capacity (FC) and Framingham risk score (FRS). The objective of this study was to verify the correlation between ABI, LVH, FC and FRS in men with arterial hypertension (AH). Prospective and cross-sectional study of male patients (n = 40) with a mean age of 57.92 ± 7.61 years and no cardiovascular complications. This population was submitted to ABI measurements, echocardiography (ECHO), exercise test (ET) and laboratory tests. The ABI (right and left) was considered abnormal when the ratio between the highest mean systolic pressures of the ankles and arms was 0.9 or higher than 1.3 mmHg. LVH was identified by transthoracic ECHO and the FC by the ET. Peripheral blood samples were collected to calculate the FRS. Normal ABI values were observed in 33 patients (82.5%), who were included in Group I; seven patients (17.5%) with abnormal ABI constituted Group II. Left ventricular mass index (LVMI) at the ECO were 111.18 ± 34.34 g/m2 (Group I) and 150.29 ± 34.06 g/m2 (Group II) (p = 0.009). The prevalence of LVH was 4% (Group I) and 35.3% (Group II) (p = 0.01), demonstrating a significant difference between the groups. As for the FC in ET, there was no difference between the groups. Regarding the FRS, the mean in Group I was below that in Group II: 13.18 ± 2.11 versus 15.28 ± 1.79 (p = 0.019). In hypertensive patients, the presence of LVH defined by the LVMI was more frequent in cases with abnormal ABI, identifying a higher cardiovascular risk.The ankle-brachial index (ABI) is a marker of peripheral arterial disease. Very few reports have correlated this index with left ventricular hypertrophy (LVH), functional capacity (FC) and Framingham risk score (FRS). The objective of this study was to verify the correlation between ABI, LVH, FC and FRS in men with arterial hypertension (AH). Prospective and cross-sectional study of male patients (n = 40) with a mean age of 57.92 ± 7.61 years and no cardiovascular complications. This population was submitted to ABI measurements, echocardiography (ECHO), exercise test (ET) and laboratory tests. The ABI (right and left) was considered abnormal when the ratio between the highest mean systolic pressures of the ankles and arms was 0.9 or higher than 1.3 mmHg. LVH was identified by transthoracic ECHO and the FC by the ET. Peripheral blood samples were collected to calculate the FRS. Normal ABI values were observed in 33 patients (82.5%), who were included in Group I; seven patients (17.5%) with abnormal ABI constituted Group II. Left ventricular mass index (LVMI) at the ECO were 111.18 ± 34.34 g/m(2) (Group I) and 150.29 ± 34.06 g/m(2) (Group II) (p = 0.009). The prevalence of LVH was 4% (Group I) and 35.3% (Group II) (p = 0.01), demonstrating a significant difference between the groups. As for the FC in ET, there was no difference between the groups. Regarding the FRS, the mean in Group I was below that in Group II: 13.18 ± 2.11 versus 15.28 ± 1.79 (p = 0.019). In hypertensive patients, the presence of LVH defined by the LVMI was more frequent in cases with abnormal ABI, identifying a higher cardiovascular risk.

Correlation between heart rate control during exercise and exercise capacity in patients with chronic atrial fibrillation.

Rate control is an acceptable alternative to rhythm control in patients with chronic atrial fibrillation (AF).

Influence of Heart Rate on Quality of Life in Patients With Chronic Atrial Fibrillation

Current criteria for rate control in atrial fibrillation (AF) treatment are empirical and based on a small amount of scientific data.

Reabilitação não supervisionada ou semi-supervisionada: uma alternativa prática

Escola Paulista de Medicina UNIFESP Endereco para correspondencia: Japy Angelini Oliveira Filho Rua Tapejara, l09 Cep 05594-050 Sao Paulo SP E-mail: japyaof@cardiol.br; japyoliveira@uol.com.br Enviado para Publicacao em 25/06/2003 Aceito em 16/06/2004 Ha seculos a medicina chinesa reconhece os beneficios do exercicio para a saude. Huang-Ti, o imperador Amarelo, viveu na China em 2600 a.C. e a ele e atribuida a autoria do Nei Ching, onde consta a citacao: “O corpo precisa de exercicio, so que nao deve ser ao ponto de exaustao. O exercicio expele o ar viciado do organismo, melhora a livre circulacao do sangue e afasta a doenca. Os degraus da porta sempre usados jamais apodrecem. E, por isso, que os antigos praticavam os movimentos... para evitarem a velhice”.

A elevação da pressão arterial sistólica durante o teste ergométrico após transplante cardíaco: correlação com o quadro clínico e a função ventricular avaliada pela ecocardiografia sob estresse com dobutamina

OBJECTIVE: Patients who underwent heart transplantation (HTX) experience a reduction in the elevation that is usual in systolic blood pressure during exercise testing. Of unknown origin, this phenomenon varies in frequency and intensity. The aim of this study was to analyze the relationship between systolic blood pressure increase (delta SBP) and clinical aspects, as well as variables measured during exercise testing (ET) and dobutamine stress echocardiography (DSE) in patients in the late post-transplantation course. METHODS: Forty-five men, mean age 49.04 ± 10.19, underwent clinical assessment, ET and DSE 40.91 ± 27.46 months after heart transplantation. Left ventricular wall motion score index and ejection fraction were assessed. Delta SBP < 35mmHg during ET was considered abnormal (SBC,1995). RESULTS: No significant correlation was found between delta SBP and post-transplantation time, graft ischemic time, history of rejection, diltiazem dosage, oxygen uptake, ejection fraction, and wall motion score index (WMSI). Delta SBP was normal in 17 patients (Group I) and abnormal in 28 (Group II). Patients of both groups did not differ significantly in regard to clinical features and ET and DSE results. CONCLUSION: Unlike other populations, no correlation was found between delta SBP during exercise testing and clinical condition or left ventricular function in heart transplant patients. Pathophysiological factors associated with delta SBP reduction during exercise testing remain unknown.

Unsupervised Rehabilitation: effects of Exercise Training over the Long Run

OBJECTIVE To assess the safety and efficacy of unsupervised rehabilitation (USR) in the long run in low-risk patients with coronary artery disease. METHODS We carried out a retrospective study with 30 patients divided into: group I (GI) - 15 patients from private clinics undergoing unsupervised rehabilitation; group II (GII) - control group, 15 patients from ambulatory clinic basis, paired by age, sex, and clinical findings. GI was stimulated to exercise under indirect supervision (jogging, treadmill, and sports). GII received the usual clinical treatment. RESULTS The pre- and postobservation values in GI were, respectively: VO2 peak (mL/kg/min), 24+/-5 and 31+/- 9; VO2 peak/peak HR: 0.18+/-0.05 and 0.28+/-0.13; peak double product (DP peak):26,800+/-7,000 and 29,000 +/- 6,500; % peak HR/predicted HRmax: 89.5+/-9 and 89.3+/-9. The pre- and post- values in GII were: VO2 peak (mL/kg/min), 27+/- 7 and 28+/-5; VO2 peak/peak HR: 0.2+/-0.06 and 0.2+/- 0.05; DP peak: 24,900+/-8,000 and 25,600+/- 8,000, and % peak HR/predicted HRmax: 91.3+/-9 and 91.1+/- 11. The following values were significant: preobservation VO2 peak versus postobservation VO2 peak in GI (p=0.0 063); postobservation VO2 peak in GI versus postobservation VO2 peak in GII (p=0.0045); postobservation VO2 peak/peak HR GI versus postobservation peak VO2/peak HR in GII (p=0.0000). The follow-up periods in GI and GII were, respectively, 41.33+/- 20.19 months and 20.60+/-8.16 months (p<0.05). No difference between the groups was observed in coronary risk factors, therapeutic management, or evolution of ischemia. No cardiovascular events secondary to USR were observed in 620 patient-months. CONCLUSION USR was safe and efficient, in low-risk patients with coronary artery disease and provided benefits at the peripheral level.